Leiba Adi, Goldberg Avi, Hourvitz Ariel, Amsalem Yoram, Aran Adi, Weiss Gali, Leiba Ronit, Yehezkelli Yoav, Goldberg Avishay, Levi Yehezkel, Bar-Dayan Yaron
Israeli Defense Forces Home Front Command, Ramat-Gan, Israel.
Ann Emerg Med. 2006 Aug;48(2):194-9, 199.e1-2. doi: 10.1016/j.annemergmed.2005.12.006.
Emergency department (ED) physicians and nurses are considered critical sentinels of a bioterrorist attack. We designed a special hospital drill to test EDs' response to inhalational anthrax and assess the level of preparedness for anthrax bioterrorism. We hypothesized that the occurrence of such a drill in an ED would improve the knowledge of its physicians, even those who had not actually participated in the drill.
We conducted 23 drills at all Israeli general hospitals' EDs. An actor entered the walk-in triage area, simulating a febrile patient with lower respiratory complaints. A chest radiograph with mediastinal widening, as can be seen in early anthrax disease, was planted in the hospital's imaging results system. Patients were instructed to give additional epidemiologic clues, such as having a few friends with a similar syndrome. Either before or after the drills, we distributed multiple choice tests about diagnosis and management of anthrax to the 115 senior emergency physicians at these hospitals.
In 91% of EDs, a decision to admit the patient was made. Sixty-one percent included anthrax in the differential diagnosis and activated the appropriate protocols. Only 43% contacted all relevant officials. Average score on the anthrax tests was 58 (of 100). Physicians who were tested before the drill (in their institution) achieved a mean score of 54.5, whereas those who were tested after their ED had been exercised achieved a mean score of 59.3.
A national framework of drills on bioterrorism can help estimate and potentially augment national preparedness for bioterrorist threats. It is not, on its own, an effective educational tool. More emphasis should be given to formal accredited continuing medical education programs on bioterrorism, especially for emergency physicians and ED nurses, who will be in the front line of a bioterrorist attack.
急诊科医生和护士被视为生物恐怖袭击的关键哨兵。我们设计了一项特殊的医院演练，以测试急诊科对吸入性炭疽的应对能力，并评估针对炭疽生物恐怖主义的准备水平。我们假设在急诊科进行这样的演练将提高其医生的知识水平，即使是那些未实际参与演练的医生。
我们在以色列所有综合医院的急诊科进行了23次演练。一名演员进入即看即诊分诊区，模拟一名有下呼吸道症状的发热患者。将一张显示纵隔增宽的胸部X光片（早期炭疽病可见）植入医院的影像结果系统。患者被要求提供额外的流行病学线索，比如有几个患有类似综合征的朋友。在演练之前或之后，我们向这些医院的115名资深急诊医生发放了关于炭疽诊断和治疗的多项选择题测试。
在91%的急诊科中，做出了收治患者的决定。61%将炭疽纳入鉴别诊断并启动了相应预案。只有43%的急诊科联系了所有相关官员。炭疽测试的平均分数为58分（满分100分）。在演练前（在其所在机构）接受测试的医生平均得分为54.5分，而在其所在急诊科进行演练后接受测试的医生平均得分为59.3分。
生物恐怖主义演练的国家框架有助于评估并可能增强国家应对生物恐怖主义威胁的准备能力。但其本身并非一种有效的教育工具。应更加重视关于生物恐怖主义的正规认可的继续医学教育项目，尤其是针对将处于生物恐怖袭击一线的急诊医生和急诊科护士。
